C-Reactive Protein Level, Could Be a Useful Predictor of LV Systolic Dysfunction Post Myocardial Infarction
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C-Reactive Protein Level, Could Be a Useful Predictor of LV Systolic Dysfunction Post Myocardial Infarction,AHMAD ABD ELRAZIK OTHMAN
Abstract
Background: C-reactive protein is an acute phase protein that is produced predominantly by hepatocytes under the influence of cytokines such as interleukin (IL)-6 and tumor necrosis factor-alpha, which increased in response to infection, ischemia, trauma, burns, and inflammatory conditions. Ligand-bound or aggregated C-reactive protein binds C1q and in so doing activates the classical complement pathway.
A growing number of studies suggest that C-reactive protein is an independent risk factor for vascular disease, the baseline plasma concentration of C-reactive protein predicts the risk of future myocardial infarction and stroke and is associated with a poor prognosis in unstable angina.
C-reactive protein estimation can help in predicting short-and long-term prognosis after acute myocardial infarction. High plasma C-reactive protein level in the acute phase strongly indicates a poor clinical outcome of the patients with myocardial infarction.
Aim of the Study: To assess the relationship between the admission C-reactive protein levels and left ventricular function in patients with acute myocardial infarction.
Patients and Methods: Thirty patients 26 males (86.6%) and 4 females (13.4%) with a mean age of 52±9.82 years, with recent ST elevation myocardial infarction were included in the study over the period from August 2004 to July 2005. All patients included in the study were presenting with symp-toms of recent myocardial infarction.
Following admission all patients were subjected to full medical history, clinical examination, standard 12-lead ECG, and routine laboratory investigations including cardiac enzymes (CK, CK-MB and LDH) and venous blood samples for C-reactive protein were obtained at time of admission.
Assessment of left ventricular function by echocardio-graphy was done to all patients on day 2 or 3 of hospitalization.
Result: Based on C-reactive protein level we classified the patients into two groups. Group A: Including patients with CRP level £2.5mg/dl, (mean 1.36±0.81mg/dl), (n=16). Group B: Including patients with CRP level >2.5mg/dl, (mean 6.42±3.87mg/dl), (n=14).
The mean C-reactive protein level was significantly higher in group B than group A (6.42±3.87 Vs 1.36±0.81), p value
0.05 and the mean CK and CK-MB level was higher in Group B (528±691.5 & 46.3±2.7U/L) than in Group A (342.3±589.3 & 30.1±2.1U/L) respectively, but the p value was not signif-icant.
LVEDV was significantly higher in group B than group A (79.17±17.2 Vs 62.3±18.6) p value 0. 04, LVESV also was significantly higher in group B than group A (39.4±12.2 Vs 26.9±10.6) p value 0.035.
And LV EF was significantly lower in group B Compared to group A (46.7±11.9% Vs 56.9±7.7%) p value 0.02. And the Severity of diastolic dysfunction was significantly greater in Group B (diastolic dysfunction grade II-III; E/A ratio 1.8±0.3) than in Group A (diastolic dysfunction grade I-II; E/A ratio 1.1±0.2).
In Conclusion: C-reactive protein could be used as an index of the severity of myocardial necrosis and prediction of LV systolic dysfunction.